scholarly journals Bedside detection of intracranial midline shift using portable magnetic resonance imaging

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Kevin N. Sheth ◽  
Matthew M. Yuen ◽  
Mercy H. Mazurek ◽  
Bradley A. Cahn ◽  
Anjali M. Prabhat ◽  
...  
Keyword(s):  
Standard Of Care ◽  
Mass Effect ◽  
New Haven ◽  
Midline Shift ◽  
Low Field ◽  
Final Study ◽  
Brain Injured ◽  
Neuroscience Intensive Care Unit ◽  
Injured Patients ◽  
Low Magnetic Field

AbstractNeuroimaging is crucial for assessing mass effect in brain-injured patients. Transport to an imaging suite, however, is challenging for critically ill patients. We evaluated the use of a low magnetic field, portable MRI (pMRI) for assessing midline shift (MLS). In this observational study, 0.064 T pMRI exams were performed on stroke patients admitted to the neuroscience intensive care unit at Yale New Haven Hospital. Dichotomous (present or absent) and continuous MLS measurements were obtained on pMRI exams and locally available and accessible standard-of-care imaging exams (CT or MRI). We evaluated the agreement between pMRI and standard-of-care measurements. Additionally, we assessed the relationship between pMRI-based MLS and functional outcome (modified Rankin Scale). A total of 102 patients were included in the final study (48 ischemic stroke; 54 intracranial hemorrhage). There was significant concordance between pMRI and standard-of-care measurements (dichotomous, κ = 0.87; continuous, ICC = 0.94). Low-field pMRI identified MLS with a sensitivity of 0.93 and specificity of 0.96. Moreover, pMRI MLS assessments predicted poor clinical outcome at discharge (dichotomous: adjusted OR 7.98, 95% CI 2.07–40.04, p = 0.005; continuous: adjusted OR 1.59, 95% CI 1.11–2.49, p = 0.021). Low-field pMRI may serve as a valuable bedside tool for detecting mass effect.

scholarly journals Immunomodulatory Effect of Hypertonic Saline Solution in Traumatic Brain-Injured Patients and Intracranial Hypertension

2020 ◽  
Vol 17 (02) ◽  
pp. 074-078
Author(s):  
Gabriel A. Quiñones-Ossa ◽  
Adesh Shrivastava ◽  
William Andres Florez Perdomo ◽  
Luis R. Moscote-Salazar ◽  
Amit Agrawal
Keyword(s):  
Hypertonic Saline ◽  
Saline Solution ◽  
Surgical Intervention ◽  
Neuronal Damage ◽  
Mass Effect ◽  
Hypertonic Saline Solution ◽  
Secondary Damage ◽  
Brain Injured ◽  
Injured Patients

AbstractTraumatic brain injury (TBI) is often associated with an increase in the intracranial pressure (ICP). This increase in ICP can cross the physiological range and lead to a reduction in cerebral perfusion pressure (CPP) and the resultant cerebral blood flow (CBF). It is this reduction in the CBF that leads to the secondary damage to the neural parenchyma along with the physical axonal and neuronal damage caused by the mass effect. In certain cases, a surgical intervention may be required to either remove the mass lesion (hematoma of contusion evacuation) or provide more space to the insulted brain to expand (decompressive craniectomy). Whether or not a surgical intervention is performed, all these patients require some form of pharmaceutical antiedema agents to bring down the raised ICP. These agents have been broadly classified as colloids (e.g., mannitol, glycerol, urea) and crystalloids (e.g., hypertonic saline), and have been used since decades. Even though mannitol has been the workhorse for ICP reduction owing to its unique properties, crystalloids have been found to be the preferred agents, especially when long-term use is warranted. The safest and most widely used agent is hypertonic saline in various concentrations. Whatever be the concentration, hypertonic saline has created special interest among physicians owing to its additional property of immunomodulation and neuroprotection. In this review, we summarize and understand the various mechanism by which hypertonic saline exerts its immunomodulatory effects that helps in neuroprotection after TBI.

Specific Computerized Attention Training in Stroke and Traumatic Brain-Injured Patients

2003 ◽  
Vol 14 (4) ◽  
pp. 283-292 ◽  
Author(s):  
W. Sturm ◽  
B. Fimm ◽  
A. Cantagallo ◽  
N. Cremel ◽  
P. North ◽  
...  
Keyword(s):  
Divided Attention ◽  
Single Case ◽  
Baseline Period ◽  
Specific Training ◽  
Attention Task ◽  
Baseline Phase ◽  
Computerized Training ◽  
Brain Injured ◽  
Divided Attention Task ◽  
Injured Patients

Abstract: In a multicenter European approach, the efficacy of the AIXTENT computerized training programs for intensity aspects (alertness and vigilance) and selectivity aspects (selective and divided attention) of attention was studied in 33 patients with brain damage of vascular and traumatic etiology. Each patient received training in one of two most impaired of the four attention domains. Control tests were performed by means of a standardized computerized attention test battery (TAP) comprising tests for the four attention functions. Assessment was carried out at the beginning and at the end of a four week baseline period and after the training period of 14 one-hour sessions. At the end of the baseline phase, there was only slight but significant improvement for the most complex attention function, divided attention (number of omissions). After the training, there were significant specific training effects for both intensity aspects (alertness and vigilance) and also for the number of omissions in the divided attention task. The application of inferential single case procedures revealed a high number of significant improvements in individual cases after specific training of alertness and vigilance problems. On the other hand, a non specific training addressing selectivity aspects of attention lead either to improvement or deterioration of alertness and vigilance performance. The results corroborate the findings of former studies with the same training instrument but in patients with different lesion etiologies.

How to manage fever in brain-injured patients

2020 ◽  
Vol 86 (1) ◽  
Author(s):  
Edoardo Picetti ◽  
Francesco Minardi ◽  
Sandra Rossi
Keyword(s):  
Brain Injured ◽  
Injured Patients

Convergence insufficiency in brain-injured patients

Brain Injury ◽  
1989 ◽  
Vol 3 (2) ◽  
pp. 187-191 ◽  
Author(s):  
M. Cohen ◽  
Z. Groswasser ◽  
R. Barchadski ◽  
A. Appel
Keyword(s):  
Convergence Insufficiency ◽  
Brain Injured ◽  
Injured Patients

scholarly journals Patient–ventilator asynchrony in acute brain-injured patients: a prospective observational study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Xu-Ying Luo ◽  
Xuan He ◽  
Yi-Min Zhou ◽  
Yu-Mei Wang ◽  
Jing-Ran Chen ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Esophageal Pressure ◽  
Respiratory Drive ◽  
Asynchrony Index ◽  
Mechanically Ventilated ◽  
Airway Occlusion ◽  
Brain Injured ◽  
Injured Patients ◽  
Duration Of Ventilation ◽  
Ventilated Patients

Abstract Background Patient–ventilator asynchrony is common in mechanically ventilated patients and may be related to adverse outcomes. Few studies have reported the occurrence of asynchrony in brain-injured patients. We aimed to investigate the prevalence, type and severity of patient–ventilator asynchrony in mechanically ventilated patients with brain injury. Methods This prospective observational study enrolled acute brain-injured patients undergoing mechanical ventilation. Esophageal pressure monitoring was established after enrollment. Flow, airway pressure, and esophageal pressure–time waveforms were recorded for a 15-min interval, four times daily for 3 days, for visually detecting asynchrony by offline analysis. At the end of each dataset recording, the respiratory drive was determined by the airway occlusion maneuver. The asynchrony index was calculated to represent the severity. The relationship between the prevalence and the severity of asynchrony with ventilatory modes and settings, respiratory drive, and analgesia and sedation were determined. Association of severe patient–ventilator asynchrony, which was defined as an asynchrony index  ≥ 10%, with clinical outcomes was analyzed. Results In 100 enrolled patients, a total of 1076 15-min waveform datasets covering 330,292 breaths were collected, in which 70,156 (38%) asynchronous breaths were detected. Asynchrony occurred in 96% of patients with the median (interquartile range) asynchrony index of 12.4% (4.3%–26.4%). The most prevalent type was ineffective triggering. No significant difference was found in either prevalence or asynchrony index among different classifications of brain injury (p > 0.05). The prevalence of asynchrony was significantly lower during pressure control/assist ventilation than during other ventilatory modes (p < 0.05). Compared to the datasets without asynchrony, the airway occlusion pressure was significantly lower in datasets with ineffective triggering (p < 0.001). The asynchrony index was significantly higher during the combined use of opioids and sedatives (p < 0.001). Significantly longer duration of ventilation and hospital length of stay after the inclusion were found in patients with severe ineffective triggering (p < 0.05). Conclusions Patient–ventilator asynchrony is common in brain-injured patients. The most prevalent type is ineffective triggering and its severity is likely related to a long duration of ventilation and hospital stay. Prevalence and severity of asynchrony are associated with ventilatory modes, respiratory drive and analgesia/sedation strategy, suggesting treatment adjustment in this particular population. Trial registration The study has been registered on 4 July 2017 in ClinicalTrials.gov (NCT03212482) (https://clinicaltrials.gov/ct2/show/NCT03212482).

scholarly journals Longitudinal fixel-based analysis reveals restoration of white matter alterations following balance training in young brain injured patients

2021 ◽  
pp. 102621
Author(s):  
Xiaoyun Liang ◽  
Chun-Hung Yeh ◽  
Juan F. Domínguez D ◽  
Govinda Poudel ◽  
Stephan P. Swinnen ◽  
...  
Keyword(s):  
White Matter ◽  
Balance Training ◽  
Brain Injured ◽  
Injured Patients
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